NBME Answers : Block 3 : #13 = A 32-year-old man is brought to the emergency ...

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submitted by benwhite_dotcom(60),

Blood at the meatus is the red flag (see what I did there?) for urethral injury, which should be evaluated for with a retrograde urethrogram. The membranous the most commonly injured by fracture. In contrast, the spongy urethra is most likely to be injured during traumatic catheter insertion or in a straddle injury.

canyon_run Should we just assume that a pelvic fracture implies a membranous urethral injury? I was between membranous and spongy and I ended up choosing spongy because of the perineal bruising and fact that the patient was riding a motorcycle (and therefore susceptible to straddle injury). +

benwhite_dotcom Yes. You should think of spongy as the penile urethra, hence the predisposition to catheter-related trauma. +2